Convenience is touted. So are incentives: CVS offers a 20-percent-off shopping pass for everyone who gets a shot, while Walgreens donates toward international vaccination efforts.

The start of flu season is still weeks — if not months — away. Yet marketing of the vaccine has become an almost year-round effort, beginning when the shots become available in August and hyped as long as the supply lasts, often into April or May.

Not that long ago, most flu-shot campaigns started as the leaves began to turn in October. But the rise of retail medical clinics inside drug stores over the past decade — and state laws allowing pharmacists to give vaccinations — has stretched the flu-shot season.

The stores have figured out how “to deliver medical services in an on-demand way” which appeals to customers, particularly millennials, said Tom Charland, founder and CEO of Merchant Medicine, which tracks the walk-in clinic industry. “It’s a way to get people into the store to buy other things.”

But some experts say the marketing may be overtaking medical wisdom since it’s unclear how long the immunity imparted by the vaccine lasts, particularly in older people.

Federal health officials say it’s better to get the shot whenever you can. An early flu shot is better than no flu shot at all. But the science is mixed when it comes to how long a flu shot promoted and given during the waning days of summer will provide optimal protection, especially because flu season generally peaks in mid-winter or beyond. Experts are divided on how patients should respond to such offers.

“If you’re over 65, don’t get the flu vaccine in September. Or August. It’s a marketing scheme,” said Laura Haynes, an immunologist at the University of Connecticut Center on Aging.

That’s because a combination of factors makes it more difficult for the immune systems of people older than age 65 to respond to the vaccination in the first place. And its protective effects may wear off faster for this age group than it does for young people.

When is the best time to vaccinate? It’s a question even doctors have.

“Should I wait until October or November to vaccinate my elderly or medically frail patients?” That’s one of the queries on the website of the board that advises the Centers for Disease Control and Prevention on immunizations. The answer is that it is safe to make the shots available to all age groups when the vaccine becomes available, although it does include a caution.

The board says antibodies created by the vaccine decline in the months following vaccination “primarily affecting persons age 65 and older,” citing a study done during the 2011-2012 flu season. Still, while “delaying vaccination might permit greater immunity later in the season,” the CDC notes that “deferral could result in missed opportunities to vaccinate.”

How long will the immunity last?

“The data are very mixed,” said. John J. Treanor, a vaccine expert at the University of Rochester medical school. Some studies suggest vaccines lose some protectiveness during the course of a single flu season. Flu activity generally starts in the fall, but peaks in January or February and can run into the spring.

“So some might worry that if [they] got vaccinated very early and flu didn’t show up until very late, it might not work as well,” he said.

But other studies “show you still have protection from the shot you got last year if it’s a year when the strains didn’t change, Treanor said.

In any given flu season, vaccine effectiveness varies. One factor is how well the vaccines match the virus that is actually prevalent. Other factors influencing effectiveness include the age and general health of the recipient. In the overall population, the CDC says studies show vaccines can reduce the risk of flu by about 50 to 60 percent when the vaccines are well matched.

Health officials say it’s especially important to vaccinate children because they often spread the disease, are better able to develop antibodies from the vaccines and, if they don’t get sick, they won’t expose grandma and grandpa. While most people who get the flu recover, it is a serious disease responsible for many deaths each year, particularly among older adults and young children. Influenza’s intensity varies annually, with the CDC saying deaths associated with the flu have ranged from about 3,300 a year to 49,000 during the past 31 seasons.

To develop vaccines, manufacturers and scientists study what’s circulating in the Southern Hemisphere during its winter, which is our summer. Then — based on that evidence — forecast what flu strains might circulate here to make vaccines that are generally delivered in late July.

For the upcoming season, the vaccines will include three or four strains, including two A strains, an H1N1 and an H3N2, as well as one or two B strains, according to the CDC. It recommends that everyone older than 6 months get vaccinated, unless they have health conditions that would prevent it.

The vaccines can’t give a person the flu because the virus is killed before it’s included in the shot. This year, the nasal vaccine is not recommended for use, as studies showed it was not effective during several of the past flu seasons.

But when to go?

“The ideal time is between Halloween and Thanksgiving,” said Haynes at UConn. “If you can’t wait and the only chance is to get it in September, then go ahead and get it. It’s best to get it early rather than not at all.”

]]>https://ww2.kqed.org/stateofhealth/2016/09/15/you-may-want-to-hold-off-on-getting-your-flu-shot-doctors-say/feed/3People Say They Go To Work Sick — Even When They Shouldn’thttps://ww2.kqed.org/stateofhealth/2016/07/11/people-say-they-go-to-work-sick-even-when-they-shouldnt/
Mon, 11 Jul 2016 21:12:30 +0000http://ww2.kqed.org/stateofhealth/?p=211512A majority of working adults say they still go to work when they have a cold or the flu. There are some jobs where doing that can have a big effect on health.

At least half of people who work in very public places, like hospitals and restaurants, report going to work when they have a cold or the flu. Those were among the findings of a poll conducted by NPR, the Robert Wood Johnson Foundation and the Harvard T.H. Chan School of Public Health.

They are some of the last people you’d want to go to work sick, because they tend to have a lot of contact with people. And that helps spread disease.

“It’s one of the biggest food safety problems that there is, and we’ve known about it forever,” says Kirk Smith, who oversees foodborne outbreak investigations with the Minnesota Department of Health. But he says it’s really hard to get people to stop doing it.

When it comes to food handling, there’s one illness that’s particularly concerning: norovirus. “It is by far the most common cause of foodborne illness,” says Smith. According to the Centers for Disease Control and Prevention, the virus is responsible for 35 percent of them.

That’s because there are billions of virus particles per gram in stool and vomit. It takes only about 20 of those to get someone sick. And norovirus can hitchhike from surface to surface. It takes a high concentration of bleach to kill it.

“And so it just takes microcontamination of your hands, if you don’t do a perfect job washing, to be able to contaminate food with enough of the virus to infect lots and lots of people,” says Smith.

The same virus has plagued restaurant customers across the country. Last winter, 140 people — including much of the Boston College basketball team — got sick from eating at a Chipotle in Boston where one person had gone to work sick.

“It’s definitely the norm to go into work sick. That’s what I and most of my co-workers usually do,” says Anthony Peeples. He used to work at an Olive Garden restaurant. Now he’s a bartender at a casino in Michigan City, Indiana.

Workers clean a closed Chipotle restaurant in Boston in December after customers became infected with norovirus. (Suzanne Kreiter/Boston Globe via Getty Images)

At Olive Garden, he says, he was in a bind when he got sick, because he didn’t have any paid sick leave.

“I don’t think anybody really wants to go out there and get people sick or let alone work when they’re miserable, but you have to,” he says, “Or else you’re not going to be able to pay your electricity or water or your rent.”

The Food and Drug Administration has something called the Food Code that says food workers need to stay home 24 hours after their symptoms go away, but not all states have adopted the rule.

The CDC has found that one in five food service workers has reported working while sick with vomiting and diarrhea.

People don’t want to leave their colleagues in the lurch, says Laura Brown, a behavioral scientist with the CDC’s National Center for Environmental Health.

She and her colleagues interviewed employees at about 500 restaurants in nine different states and then calculated which factors were most strongly linked to people going to work sick.

“Forty percent of workers did say to us that they’d worked while sick in the past because they wouldn’t get paid,” Brown says. “But when we look at the data statistically, that doesn’t really seem to be a large driving factor in whether or not people actually work when they’re sick.”

A lot of them went to work because they were worried about losing their jobs if they didn’t show. And there was another thing. “We found that workers who were concerned about leaving their co-workers short-staffed were more likely to say they’d worked while sick,” Brown says.

Likewise, those who worked in places that had backup options — like on-call workers to fill in for sick staff — were less likely to work while sick. So the biggest factor, Brown says, was that “the workers are concerned about their co-workers having to work a man down.”

NPR’s poll also found that it isn’t always money that drives people to work when they should stay home.

Adults in low-paying jobs are more likely to say they go to work ill — but about half of those in high-paying jobs are, too.

Copyright 2016 NPR. To see more, visit http://www.npr.org/.

]]>Workers clean a closed Chipotle restaurant in Boston in December after customers became infected with norovirus.Workers clean a closed Chipotle restaurant in Boston in December after customers became infected with norovirus.Screen Shot 2016-07-11 at 2.06.45 PMWhat Offers Better Immunity: The Flu Vaccine or the Flu Itself?https://ww2.kqed.org/stateofhealth/2016/02/24/better-immunity-from-flu-vaccine-or-flu-itself/
https://ww2.kqed.org/stateofhealth/2016/02/24/better-immunity-from-flu-vaccine-or-flu-itself/#respondWed, 24 Feb 2016 18:09:21 +0000http://ww2.kqed.org/stateofhealth/?p=152601This year’s flu season has been fairly mild so far, as predicted. But also as predicted, flu cases have been picking up, in line with the expected February peak this year. The most recent report from the Centers for Disease Control and Prevention shows an increase in influenza-like illnesses and notes that it’s never too late to get vaccinated.
The big problem with immunity you might get from having the flu … is that you have to actually get the flu. It can be a serious illness.

But the flu vaccines varies widely in its effectiveness from year to year. So, how worthwhile is it, really? You could instead take your chances with the flu, and if you get it, you’ll have even better immunity to the flu in the future anyway, right?

Unfortunately, it’s not that simple.

There are two things to unpack here: how effective the flu vaccine is and whether getting the flu might protect someone more than the vaccine from future illness. Both of these start with understanding the virus itself.

“What makes the flu virus so confusing and tricky is it mutates,” explained Dr. Kawsar R. Talaat with the Center For Immunization Research at Johns Hopkins Bloomberg School of Public Health. “When it makes copies of itself, it does so sloppily, and there are mistakes made,” Talaat said. “Some of those mistakes don’t work — the virus doesn’t leave the cell or dies — but occasionally in the copying process, it allows the virus to be a little bit better at infecting the next person.”

“With flu, we’re dealing with a very cool virus,” Tan said. “It’s got these great ways of switching around its genes so it can look different, and it wants to look different so it can better evade the immune system.”

These rapid mutations account for the different strains among the four basic types of flu viruses that infect humans. That variety of strains partly explains the variation in the flu vaccine’s effectiveness. To make an effective vaccine, public health officials must predict which strains will be circulating almost a year ahead of time, all while the virus is a moving target.

The vaccine’s effectiveness falls short for other reasons too, Talaat said.

A person’s “immune response to flu vaccine is not perfect, so effectiveness will never be 100 percent even if the strains perfectly match,” Talaat said.

Further, even if strains or antibodies match well, each new vaccine’s ability to induce an immune response varies.

Finally, individuals respond differently to the vaccine. Older adults do not mount as strong a defense because their immune systems are older. Infants don’t mount a strong response because their immune systems aren’t fully developed yet. And if you’re in the middle — being sick, tired, sleep-deprived or otherwise run down in some way may affect how well your own body responds.

Then there’s the evidence suggesting annual flu shots are less effective when you’ve had one the previous year. One possible explanation for this is that the body’s response to a previous year’s vaccine blunts the response the following year, Tan said, but scientists are still trying to understand it. A blunted immune response from the vaccine, however, still offers more protection than not getting the vaccine at all.

“Until we get a true handle on what the mechanism could be, the current recommendation is the best one we have,” Tan said.

At this point you might be thinking — maybe I’ll just take the immunity I would get from contracting the flu itself.

A student gets a “flu mist” vaccine during a clinic at his Oakland elementary school. The Centers for Disease Control says people ages 2-49 can get this nasal spray vaccine. (James Tensuan/KQED)

That might make some sense — except it requires actually getting sick, and the flu is not a mild illness.

“The first problem with this idea is that you can get really, really sick and die from the flu,” Talaat said. “If you get the flu vaccine, even if it doesn’t protect you from getting sick, hopefully it protects you from severe disease and from death. It tends to mitigate the illness somewhat.”

It is true that a flu infection will stimulate the immune system more strongly than the vaccine will, said Tan, but that comes with a price.

“As a country, we don’t think flu is a big deal, but it is deceivingly serious,” Tan said. Deaths from flu each year vary widely, but they’re always in the thousands, ranging from 3,000 to 49,000 people a year in the U.S. “It makes absolutely no sense when we have proven safe and effective vaccine against flu — and all these other diseases — that we don’t use them,” Tan said. “It’s like throwing the dice with your child’s, your own or your grandparent’s life.”

Even aside from that gamble, however, the immunity gained from a bout of the flu only protects against that particular subtype and won’t last long because of those rapid mutations described above.

“Getting the flu and surviving is the best immunity against that particular strain of flu, but that’s just one of the four lineages, and it drifts. That one may be circulating for only three or four years,” Talaat said.

“Are you willing to get the flu every three or four years to maintain immunity to it? That doesn’t make a lot of sense.”

]]>https://ww2.kqed.org/stateofhealth/2016/02/24/better-immunity-from-flu-vaccine-or-flu-itself/feed/0RS12665_20141017_vaccines_jt_002A student gets a "flu mist" vaccine at a campaign at an Oakland elementary school. The Centers for Disease Control says people ages 2-49 can get this nasal spray vaccine.Look Out for Nasty Flu Season, CDC Sayshttps://ww2.kqed.org/stateofhealth/2014/12/04/look-out-for-nasty-flu-season-cdc-says/
https://ww2.kqed.org/stateofhealth/2014/12/04/look-out-for-nasty-flu-season-cdc-says/#respondThu, 04 Dec 2014 20:46:15 +0000http://blogs.kqed.org/stateofhealth/?p=22818(Timothy A. Clary/AFP/Getty Images)

We may be in for a nasty flu season. That’s the warning out today from the federal Centers for Disease Control and Prevention.

The CDC is worried because the most common strain of flu virus circulating in the United States is one called H3N2. In previous years, H3N2 strains have tended to send more people to the hospital than other strains — and cause more deaths, especially among the elderly, children and people with other health problems.

Another concern is that more than half of the H3N2 viruses tested so far this year have “drifted,” meaning they have mutated slightly from the strain used to make this year’s flu vaccine.

“In past season during which predominant circulating influenza viruses have been antigenically drifted, decreased vaccine effectiveness has been observed,” the CDC wrote in an alert sent to doctors.

Translation? This year’s flu vaccine may not work as well as it usually does.

The CDC emphasized, however, that the vaccine will still provide some protection, so it’s important that as many people as possible get vaccinated.

The agency also urged people at risk of flu-related complications to seek treatment as soon as possible because antiviral drugs can help reduce the severity of the flu. The medicines work best when taken within the first 48 hours of getting sick.

So far, it looks like the drugs, Tamiflu and Relenza, will work well against the strains of flu virus circulating, the CDC says.

“Clinicians should encourage all persons with influenza-like illness who are at high risk for influenza complications to seek care promptly to determine if treatment with influenza antiviral medication is warranted,” the alert says.

Update February 21, 2014: The California Department of Public Health says 278 people have died of flu so far this year, and an additional 29 deaths are under investigation. While cases have been declining for a few weeks, state health officials still recommend people get vaccinated, if they haven’t already.

State health officials have released the latest numbers on flu deaths — 202 people have died so far this year and that’s up from 147 last week. That’s the bad news, but for the first time since early January, health officials are also saying that cases appear to be declining. At least for now. Flu season generally runs three months and is “notoriously unpredictable,” said Dr. James Watt, with the California Department of Public Heatlh and recommended that everyone got vaccinated.

Here at State of Health, we’ve noticed that a lot of the same questions come up again and again. With that in mind, we’ve compiled some answers.

1. Is the flu shot really the best way I can avoid getting the flu? In a word, yes. The Centers for Disease Control (CDC) says “the single best way to protect against the flu is to get vaccinated each year.” And you need to get it annually. While everyone over age 6 months should have it, CDC says, it’s especially important for people in high risk groups including:

Getting the flu shot is not a guarantee that you will not get the flu. No vaccine is perfect, but even if you get sick, you are likely to have a more mild course of illness if you have had the vaccine. If you haven’t gotten vaccinated yet, you can find a flu shot location near you by entering your zip code on this map run by the federal government.

(As an aside, I became a fan of the flu shot after I got the flu many years ago. It came on suddenly one afternoon — but I had Bruce Springsteen tickets that night and was determined to go. I felt worse and worse all afternoon. When I got to the Coliseum, I believe I heard the first couple songs and then fell asleep. I proceeded to sleep and fight fever for the next two days, then spent another several days recovering. It was awful.)

2. Why is the H1N1 strain such a big deal? The H1N1 strain surfaced in April, 2009. The first reported cases were in Mexico, and the strain went on to cause a “pandemic” (i.e., a global epidemic). Scientists raced to create a vaccine, but it took months. In California alone, over a roughly 16 month period, more than 600 people died. What was unusual about this strain is that the death rate in adults under 65 was higher than adults over 65. Usually influenza hits the elderly harder. Epidemiologists theorize that a similar strain may have been circulating decades ago, so older adults have some immunity to H1N1. But those under 65, not so much.

3. Why does California only track flu deaths in people under 65? Taking a step back, state officials say they believe California is the only state that tracks all flu deaths in adults. The CDC samples the country and then estimates deaths for people of all ages, but does not require reporting of all flu deaths from any state. California only started tracking flu deaths on a case-by-case basis in the 2011-2012 flu season. The legislature had passed a mandatory reporting requirement in the wake of the H1N1 pandemic noted above. The state says the goal of reporting is to track the severity of the flu season. Because flu is so common in the elderly, the state says, tracking deaths in that group would not be as good an indicator of severity. And besides, it’s not required by law.

4. Can the flu shot give me the flu? In a word, no. The vaccine is created from killed viruses. While the shot cannot give you the flu, it can have minor side effects including soreness or swelling at the site of the injection, low fever or aches. Many children like the nasal spray vaccine. Here the viruses are weakened and cannot cause severe flu symptoms. But it still can cause minor side effects including runny nose, wheezing, aches and fever. CDC says that if these side effects happen, they usually start soon after vaccination and don’t last long.

5. If the flu season is peaking, then I don’t need to worry about the flu until next year, right? Um, no. This question comes up frequently in the weekly media call about flu with state health officials. They’re pretty clear that flu is unpredictable, that you can only know the season has ended after it has ended, and that even if we’re past a peak now, there could be another round — something they referred to as the “double bump.” Health officials continue to encourage everyone over age 6 months to get vaccinated. While it can take two weeks for antibodies to kick in after you get the vaccine, you will be protected after that.

Learn more:

KQED Newsroom’s Thuy Vu discussed this year’s flu season with Dr. Erica Pan, Alameda County of Public Health, and me Friday night on the program.

State health officials reported Friday that deaths from influenza have reached 147, including four children under age 18. Another 44 deaths are under investigation, but not confirmed.

The total deaths so far this flu season, which started last September, eclipses the number from all of last year — 106.

As health officials have noted all month, the H1N1 strain is circulating — that’s the same strain that led to the pandemic in 2009-2010. Younger adults are at increased risk from H1N1. The theory is that adults over 65 were exposed to H1N1 decades ago and have retained some immunity. Younger adults were (presumably) never exposed so have no natural protection.

Health officials urged all Californians over age 6 months to get a flu shot. This year’s vaccine is well-matched to the circulating strains, health officials say. They urge people who believe they have the flu to contact their doctors immediately and ask about anti-viral medications.

State health officials reported Friday that fatalities from influenza now stand at 95 statewide — with another 51 deaths reported from local jurisdictions under investigation.

That brings the total to 146 deaths — more than the 106 deaths California had during all of last year’s flu season.

“We so far have a much more severe season,” said state epidemiologist Dr. Gil Chavez with the California Department of Public Health. A child in Riverside County was among last week’s fatalities, bringing to three the number of fatalities in children statewide. All of them were under age 10.

Chavez noted that the H1N1 strain is the culprit and says the strain causes more severe disease and more deaths. In addition, it tends to hit younger people harder, in particular those with pre-existing health conditions.

While doctor’s office visits and hospitalizations for flu were fewer last week than the week prior, Chavez said it was impossible to know if the flu season is peaking. “It’s too early to tell whether or not it’s a trend,” Chavez told reporters in a media call Friday morning. “We know that the flu is rather unpredictable, and it has ebbs and flows.”

Chavez urged those who are not vaccinated to get a flu shot, saying that there’s good availability of the vaccine statewide and that it is the best way people can protect themselves from the illness. He stressed that people with chronic health conditions are at higher risk and should be vaccinated.

Pregnant women should also get the flu shot, he said. Influenza can cause more serious illness in pregnant women than in women who are not pregnant. Women can “have a healthier pregnancy and avoid complications” of the flu, he said. Plus the shot may provide some immunity to the fetus as well.

If you’ve been following this year’s flu season, you may have noted that flu deaths are only reported for people under 65. California is the only state that mandates reporting of flu deaths, said Dr. James Watt, chief of the division of communicable disease control. The surveillance was put in place in the wake of the 2009 H1N1 pandemic. Flu deaths are more common among people over age 65 and may not be an indication of the severity of the season, health officials say.

]]>https://ww2.kqed.org/stateofhealth/2014/01/24/california-flu-deaths-double-since-last-week/feed/05163535400_750563b997_b(GabrielSaldana/Flickr)Don’t Panic Over Flu — But Do Get A Flu Shot, Say Expertshttps://ww2.kqed.org/stateofhealth/2013/01/11/dont-panic-over-flu/
https://ww2.kqed.org/stateofhealth/2013/01/11/dont-panic-over-flu/#commentsFri, 11 Jan 2013 23:52:56 +0000http://blogs.kqed.org/stateofhealth/?p=9921Continue reading Don’t Panic Over Flu — But Do Get A Flu Shot, Say Experts→]]>The states colored brown in this map from the Centers for Disease Control shows where flu activity is widespread. You see that California is currently seeing “regional” activity.
(Centers for Disease Control)

If you’re worried about contracting the flu, the CDC says that an annual flu vaccine “is the best way to reduce the chances that you will get seasonal flu and lessen the chance that you will spread it to others.” The CDC recommends everyone over age 6 months go ahead and get the shot. Today in a release, Dr. Ron Chapman of the California Department of Public Health also urged Californians to be vaccinated.

“California is seeing an accelerated increase in flu activity over the past few weeks,” said Dr. Chapman in a statement. “You can help prevent further spread of the flu by getting a flu shot.”

“Californians have a little more time to prepare,” said Dr. Carol Glaser, chief of special investigations in the department’s Division of Communicable Disease Control. The rate of flu cases here is still much lower than, say, Boston, where the mayor on Wednesday declared a state of emergency.

Experts are calling 2012-13 one of the worst flu seasons of the decade, due in part to the influenza Type A strain H3N2 that is making people sicker and keeping them sick for weeks. …

Protection against H3N2 is included in the vaccine mix for 2012-13. And you can get that vaccine close to home — say, at your local pharmacy

A flu shot can take about two weeks to create an effective shield.

Despite what people may say, the flu shot cannot give you the flu. Sometimes people get the flu immediately after being vaccinated. In this case, it’s not the shot that caused the illness, but the fact that you became infected by the virus before the vaccine had a chance to create that effective shield.

In general, the flu vaccine is only about 60 percent effective — although experts say the vaccine offers at least some protection, meaning that if you get sick, you’ll hopefully have an easier bout with the illness.